Provider Demographics
NPI:1053520098
Name:THE NORTHERN NECK-MIDDLESEX FREE HEALTH CLINIC, INC.
Entity type:Organization
Organization Name:THE NORTHERN NECK-MIDDLESEX FREE HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ROSALYN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-435-0575
Mailing Address - Street 1:51 WILLIAM B GRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3852
Mailing Address - Country:US
Mailing Address - Phone:804-435-0575
Mailing Address - Fax:804-435-9017
Practice Address - Street 1:51 WILLIAM B GRAHAM CT
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3852
Practice Address - Country:US
Practice Address - Phone:804-435-0575
Practice Address - Fax:804-435-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003193183500000X
261QC1500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health